Contribution of change in glycosylated haemoglobin to insulin-associated weight gain: results of a longitudinal study in
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ORIGINAL ARTICLE
Contribution of change in glycosylated haemoglobin to insulinassociated weight gain: results of a longitudinal study in type 2 diabetic patients H. J. Jansen • J. C. Hendriks • B. E. de Galan G. Penders • C. J. Tack • G. Vervoort
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Received: 24 August 2010 / Accepted: 25 October 2010 / Published online: 11 November 2010 Ó Springer Science+Business Media, LLC 2010
Abstract To investigate the contribution of glycosylated haemoglobin change (HbA1c) on body weight in patients with type 2 diabetes after start of insulin therapy. We analysed 122 individual weight-profiles in relation to the change in HbA1c per se in these patients up to 36 months after the start of insulin therapy. Data were analysed separately for the first 9 months after commencement of insulin therapy and for the period thereafter. Within the first 9 months of insulin therapy mean body weight increased by 0.52 kg per month. HbA1c decreased from 9.9 ± 1.8 to 7.9 ± 1.3%. Only 12% of the initial weight gain could be attributed to the change in HbA1c. Furthermore, the mean monthly increase in body weight gain was reduced by 0.006 kg for every 1 kg higher body weight at baseline. From 9 to 36 months after start of insulin therapy, body weight increased by 0.1 kg/month, which was independent of change in HbA1c. Improvement of glycaemic control per se contributes little to initial weight gain after start of insulin therapy in patients with T2DM. After 9 months of insulin treatment, weight gain is unrelated to change in glycosylated haemoglobin. Other factors have to be responsible for weight gain after start of insulin therapy.
H. J. Jansen (&) B. E. de Galan G. Penders C. J. Tack G. Vervoort Department of General Internal Medicine 463, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands e-mail: [email protected] J. C. Hendriks Department of Biostatistics and Epidemiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Keywords Weight gain Insulin therapy Type 2 diabetes mellitus
Introduction Insulin therapy is frequently needed to achieve adequate glycaemic control in patients with type 2 diabetes mellitus (T2DM), but often at the expense of significant weight gain [1–3]. This weight gain is obviously undesirable in an already overweight population and may negatively affect blood pressure, lipid levels, inflammatory and fibrinolytic parameters, and may also deter further optimization of insulin therapy [4–7]. Four putative mechanisms have been proposed for this weight gain: (1) Improvement of glycaemic control (HbA1c), (2) Anabolic effect of insulin increasing fat storage, (3) A decrease in metabolic rate and a fall in energy expenditure and (4) Defensive eating habits because of (fear of) hypoglycemia [8, 9]. Most authors view the improvement in glycaemic control per se (expressed as change in HbA1c) as the major determinant of weight gain. This conclusion is based on studies that usually relate the difference in body weight between two time-points to th
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